by Al Lewis and Vik Khanna
Quite literally the only provision of the Affordable Care Act (ACA) to receive enthusiastic bipartisan support at the time of passage was workplace wellness, nicknamed the “Safeway Amendment” because Safeway (erroneously, as it turned out) claimed to have reduced healthcare spending by 40% through workplace wellness. And, also quite literally, the only provision that almost nobody supports now– other than vendors, brokers and consultants who sponge off selling these programs to 83% of America’s larger companies — is workplace wellness. Along with recommendations that ignore clinical guidelines (such recommending hazardous “biggest loser” programs) and blatantly false savings claims, the unintended consequences of this workplace wellness mania have done more harm to the economy and to society as a whole than any other aspect of health reform.
The five major harms that workplace wellness has created or exacerbated include:
1. A well-documented physician shortage. Alone among all components of health spending, the rate of doctor visits is outpacing inflation, even as a primary care physician shortage looms. One major reason for this incongruity is workplace wellness. Not only are checkups now free under another provision of ACA, but many workplace wellness programs pay employees to get them, making checkups (for the tens of millions of employees subject to these programs) the only good in history that consumers get paid to consume. The irony is that on balance these checkups are almost universally believed to be at best worthless and at worst harmful.
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2. Ostracism of overweight and (especially) obese people at work, by other employees and employers. As exemplified by a comment in Forbes: “Why should I pay because you’re fat?” these programs pit employees against one another. However, the spending difference due to weight is only about 3% when age is taken into account. Somehow employers got the idea – mostly from vendors, brokers and consultants who sell solutions — that thin people are more productive than fat people, and that there is an obesity crisis in the workplace that affects US competitiveness … even though the more obese OECD member nations are growing faster than the thinner ones. If one assumes that manufacturing jobs require more dexterity than sitting at a desk, one would expect states with more obesity to be adding manufacturing jobs more slowly, but once again, the reverse is true: states with more obesity are attracting manufacturing jobs faster than thinner ones. (This is not to say that obesity increases productivity, just that other factors matter much more even as employers obsess with obesity.)
3. Health plans making deals with drug companies to pitch controversial drugs to obese people in the name of wellness. Wellness seems to excuse everything. Aetna just made a deal to pitch drugs to obese members who didn’t ask for them. Not just any drugs but drugs that the Journal of the American Medical Association has editorialized against due to safety concerns. And — since it’s wellness, which is an employer product on which they profit from fees rather than underwriting — Aetna is offering these drugs only to self-insured employers, not to its own fully insured members. That shows how much they think they can snooker employers and how little they think of the cost-effectiveness of these drugs.
4. In attempting to create a “culture of health,” create a culture of sickness and low morale through massive overdiagnosis (truly hyperdiagnosis) thanks to a system that rewards diagnoses and tests up to four times a year – which is twenty times the frequency of testing recommended by the United States Preventive Services Task Force – and maximizes false positives. Morale is impacted because people feel bad and drop out if they gain weight. AS is obvious to everyone who is not selling or implementing these programs, employees detest them. Twice (Penn State and CVS) employees have publicly revolted, while the bribes needed to get people to participate have almost tripled to $594 in the last five years.
5. Create a workplace culture of deceit at all levels by encouraging people to lie on health risk assessments to questions only an idiot would answer truthfully, like “do you take recreational drugs?” or “How many times have you driven drunk in the last twelve months?” And they attach pedometers to their dogs to maximize steps so they get a bonus for walking. Aetna, Cigna, and many wellness vendors use methodologies they know to be obviously wrong (usually mathematically impossible) in order to “show savings,” and are supported in this endeavor by major benefits consulting firms. Meanwhile, vendors use code language to communicate to benefits brokers that they will pay them under the table, because (unlike with carrier commissions) brokers do not have to disclose these payments to their clients.
So what should be done? The answer is quite simple: prohibit wellness programs that cause mental or physical harm to participants, violate clinical guidelines or make dishonest claims. Sellers of those programs (and the brokers and consultants who procured them) would be fined, and the fines would be distributed to employees who are victimized by them.
Almost immediately following enactment of this regulation, such programs would be replaced, because everyone who makes their living off them knows they are made up. Instead of doing wellness to employees, companies would start doing wellness for employees. Instead of “playing doctor” with humiliating weigh-ins, intrusive questionnaires, counterproductive blood draws and useless annual checkups, companies would move towards healthier dietary offerings, gym memberships, time off for exercise and other enhancements that would be perceived as offers rather than threats. Freed from the need to “show savings,” companies could follow the lead of many talent-constrained technology companies and use wellness as a way to attract, retain and motivate employees, rather than humiliating and possibly harming them.
Al Lewis, president of the Disease Management Purchasing Consortium, is author of Why Nobody Believes the Numbers (Wiley, 2012), and co-author with healthcare consultant Vik Khanna of the new guidebook for CEOs and employees, Surviving Workplace Wellness … with Your Dignity, Finances, and (major) Organs Intact (THCB Press, 2014).
